title: Take-Wait-Stop: a patient-centered strategy for writing PRN medication instructions.
abstract: Recent studies have linked patient misunderstanding of label instructions for as needed (PRN) medications to dosing errors. This study conducted a preliminary field test of patient-centered PRN label instructions. Patients participated in a hypothetical dosing experiment and were randomized to a patient-centered label (referred to as "Take-Wait-Stop") or standard label. Participants were asked to demonstrate dosing the medicine over 24 hours. Three types of independent dosing errors were measured: (a) taking more than two pills at one time, (b) exceeding the maximum daily dose, and (c) waiting fewer than 4 hours between doses. Generalized linear models were used to assess the association between label type, health literacy, and sociodemographic characteristics. Participants' mean age was 39.8 years, 62.1% were female, 43.7% were White, and 72.4% had adequate literacy. Of participants, 31.8% who were shown the standard label demonstrated taking in excess of 6 pills in 24 hours compared with only 14.0% of participants who were shown the Take-Wait-Stop label (p = .05). Overall, only 1 person demonstrated he would take more than 2 pills in a single dose. Of the standard label group, 20.5% demonstrated dosing intervals of fewer than 4 hours compared with 23.3% of the Take-Wait-Stop label group (p=.75). In a multivariate model, participants who were exposed to the standard label were 2.5 times more likely to exceed the recommended maximum daily dose (95% CI [1.05, 7.70], p=.03). The Take-Wait-Stop label was beneficial in preventing participants from exceeding the maximum dose in 24 hours, although it did not significantly reduce other dosing errors.
authors.affiliation: a Department of Emergency Medicine, and the Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: McCarthy
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: King
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mullen
authors.forename: Stacy C
authors.initials: SC
authors.lastname: Bailey
authors.forename: Marina
authors.initials: M
authors.lastname: Serper
authors.forename: Kara L
authors.initials: KL
authors.lastname: Jacobson
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Parker
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D004348:Drug Labeling; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000188:drug therapy; D018802:Patient-Centered Care / Q000379:methods*
chemical_list: D000700:Analgesics; D000082:Acetaminophen